From July 1, 2026, health insurance (HI) participants who voluntarily go for outpatient examinations outside the line at some qualified medical facilities will be paid 50% of the benefit level by the HI fund for many diseases and disease groups that were previously not paid for.
This is not only a technical change in policy, but also a noteworthy adjustment towards putting patients at the center.
For many years, the story of out-of-zone medical examination and treatment has always been one of the points that makes health insurance participants concerned. In fact, many people choose medical facilities other than the initial registration place because of changing working conditions, residence or simply wanting to access more suitable services.
However, when going for outpatient examinations outside the tuyến, most cases have to pay all costs themselves, even though they are still paying full health insurance.
Therefore, expanding payment from 0% to 50% of the benefit level for diseases outside the list that are entitled to 100% is a positive sign.
The new policy recognizes the reality that people's medical examination and treatment needs are increasingly flexible and diverse, while the health system is also being organized in the direction of improving quality and reducing barriers to accessing services.
It is noteworthy that this policy still maintains the principle of cautiously managing the health insurance fund. The State does not completely open its doors for all cases of out-of-zone examinations, but applies them conditionally, at medical facilities with appropriate professional capacity and within the scope of costs paid by health insurance. This helps expand benefits for participants but does not create too much pressure on the insurance fund.
From a policy perspective, this is a step showing a shift from the mindset of "managing patients" to "serving patients". People participating in health insurance not only need to be protected when suffering from serious illnesses or requiring inpatient treatment, but also need to be supported right from outpatient visits - where the majority of daily health care needs take place.
Of course, the 50% payment level is not the final destination. Many patients still want their benefits to be expanded in the future when the fund's conditions permit. However, in the context of having to harmonize between the payment capacity of the health insurance fund and the increasing needs of the people, expanding from "not entitled" to "partially supported" is a substantial step forward.
A good HI policy not only helps people reduce the burden of medical expenses, but also must create the feeling that the HI card always accompanies them when needed.
The new regulation from July 1 is a step forward in that direction, contributing to strengthening confidence in the country's important social security policy.
